Catheter with remotely extendible instruments

ABSTRACT

An electrosurgical apparatus for performing a surgical procedure includes a housing having an elongated flexible shaft with proximal and distal ends. The shaft having a plurality of tubes disposed therein that define a corresponding plurality of working channels configured to house a corresponding plurality of surgical instruments. An actuator is dimensioned for selective reciprocation within the shaft and configured to operably engage one or more of the corresponding plurality of surgical instruments and deploy the corresponding surgical instrument to an operating cavity as needed during a surgical procedure.

TECHNICAL FIELD

The present disclosure relates to devices for use with catheters,endoscopes and other electrosurgical instruments for coagulating tissue.More particularly, the present disclosure relates to a catheter having aseries of channels disposed therein for housing a variety of selectivelyextendible and deployable surgical instruments.

BACKGROUND OF RELATED ART

This present disclosure relates to instruments and methods forperforming minimally invasive, laparoscopic or endoscopic surgicalprocedures. More particularly, the present disclosure relates toinstruments and methods that are especially suitable for procedures thatrequire or benefit from minimally invasive access to anatomicalconduits, vessels or tissue for treating the same.

Over the last several years, minimally invasive or endoscopic surgicaltools and methods have been developed for treating vessels and tissuethat are less intrusive and less traumatic. For example, with one knowntechnique, the surgeon makes a few small incisions in the abdomen andinserts one or more elongated surgical instruments, e.g., forceps,scissors, clip appliers, staplers, etc., into the incision and carefullymanipulates the instruments while viewing the operating area through anendoscope or laparoscope. These techniques are often referred to asendoscopic, laparoscopic, minimally invasive, or video-assisted surgery.References to endoscopic surgery and endoscopes below is intended toencompass all these fields, and the exemplary operations described belowwith reference to endoscopes can also be accomplished with laparoscopes,gastroscopes, and any other imaging devices which may be convenientlyused.

Typically, many of the above-described techniques require the surgeon toinsert different instruments through the working lumen of the catheterto treat tissue, separate vessels or perform other surgical procedures.As can be appreciated, this simply adds to the overall complexity of theoperation since it requires the repeated exchange of surgicalinstruments through the working lumen to perform the different tasksassociated with a given surgical procedure.

SUMMARY

The present disclosure relates to an electrosurgical apparatus forperforming a surgical procedure including a housing having an elongatedshaft with proximal and distal ends. The shaft includes a plurality oftubes disposed therein that define a corresponding plurality of workingchannels configured to house a corresponding plurality of surgicalinstruments. An actuator is included and dimensioned for selectivereciprocation within the shaft and configured to operably engage one ormore of the corresponding plurality of surgical instruments and deploythe surgical instrument to an operating cavity as needed during asurgical procedure. The actuator is configured to allow remote operationof the surgical instrument within the operating cavity.

In one embodiment, the plurality of surgical instruments are arranged inan array-like manner within the working channels of the shaft. Inanother embodiment, the plurality of surgical instruments is selectedfrom a group consisting of: vessel sealers, coagulators, biopsyinstruments, needles, probes, sensors, graspers, forceps, knives,scissors, sutures, balloon dissectors, stents, irrigators, suctiondevices, stabilizers, blunt dissectors, lasers, optical devices,implants and anchors.

In yet another embodiment, the actuator includes an actuating cableand/or an electrical cable operably connected thereto. One or more ofthe cables are utilized to engage, deploy and/or operate one or more ofthe plurality of surgical instruments.

The housing is adapted to connect to an electrosurgical generator, anirrigation source, a suction source and/or accessory equipmentconfigured to operably connect to at least one of the plurality ofsurgical instruments. The electrosurgical generator, irrigation source,suction source and/or accessory equipment may be configured to include acontroller disposed thereon for remotely controlling the actuator and/ora sensor disposed thereon for indexing the plurality of surgicalinstruments attached to the flexible shaft.

The present disclosure also relates to an electrosurgical apparatus forperforming a surgical procedure having a housing with an elongatedflexible shaft attached thereto with proximal and distal ends and aworking end including a plurality of tubes disposed therein that definea corresponding plurality of working channels configured to house acorresponding plurality of surgical instruments. The working end isselectively engageable with the distal end of the elongated shaft. Anactuator is included that is dimensioned for selective reciprocationwithin the shaft and configured to operably engage the correspondingplurality of surgical instruments and deploy one or more of thecorresponding plurality of surgical instruments to an operating cavityas needed during a surgical procedure. A sensor may be disposed on thehousing for indexing (from each of the working ends) the plurality ofsurgical instruments attached to the flexible shaft.

The present disclosure also relates to a method for performing asurgical procedure and includes the steps of: providing a housing andattaching a flexible, elongated shaft with distal and proximal ends tothe housing; engaging one or more working ends (in series) to the distalend of the housing, the working end including a plurality of tubesdisposed therein that define a corresponding plurality of workingchannels for housing a corresponding plurality of surgical instruments;and controlling an actuator to engage one or more of the correspondingplurality of surgical instruments and deploy the corresponding surgicalinstrument(s) to an operating cavity as needed for use during a surgicalprocedure.

The method may also include the steps of indexing the plurality ofsurgical instruments disposed in the working end(s); and providingfeedback to the surgeon relating to the status and/or location(“stored”, “deployed”, “in use”, “disposed” and/or “malfunction”) ofeach of the plurality of surgical instruments.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a front, perspective view of electrosurgical instruments shownextending through working channels of a flexible shaft of a catheter inaccordance with one embodiment of the present disclosure;

FIG. 2 is a schematically-illustrated, enlarged, side perspective viewof one embodiment of the present disclosure showing a working end foruse with the elongated shaft having selectively extendable instrumentsdisposed therein;

FIG. 3 is a schematically-illustrated, internal view of the presentdisclosure showing various selectively extendible instruments disposedtherein and a deployment tool;

FIGS. 4A-4C are schematically-illustrated, greatly enlarged, sequentialviews of a biopsy tool for use with the catheter of FIG. 1;

FIG. 5 is a schematically-illustrated, enlarged view showing anexchangeable instrument magazine for use with the catheter of FIG. 1;and

FIG. 6 is a schematically-illustrated, enlarged view showing a series ofexchangeable magazines for use with the catheter of FIG. 1.

DETAILED DESCRIPTION

Referring now to FIG. 1, a multi-port catheter, generally identified byreference numeral 10 is shown. Catheter 10 includes a proximal end 13, adistal end 15 and an elongated shaft 12 disposed therebetween. In thedrawings and in the description that follows, the term “proximal”, as istraditional, will refer to the end of the forceps that is closer to theuser, while the term “distal” will refer to the end of the forceps thatis further from the user.

The proximal end 13 of catheter is operably engaged to a housing 16that, in turn, operably connects to an electrosurgical generator 50 andaccessory equipment 60 via cables 55 and 65, respectively. Accessoryequipment 60 is configured to support one or more of the variousfeatures associated with the surgical instruments attached to catheter10 as explained in more detail below, e.g., suction, irrigation, gassupply, optical equipment, steering and actuating handles and/or act asan alternate energy source for supporting instruments with alternateenergy capabilities, e.g., microwave, ultrasound, laser, etc.

As shown in FIGS. 1-3, shaft 12 is generally elongated and flexible tofacilitate negotiating various cavities and other internal structures ofan operating cavity and includes a plurality of working channels 14 a-14d defined in a general, array-like manner therein and that extendtherethrough. The shaft 12 may be rigid in an alternative embodiment.Housing 16 may include a similar plurality of channels 16 a and 16 bdefined therein that align in registration with one or more respectivechannels 14 a-14 d defined in shaft 12 to facilitate remotelycontrolling one or more surgical instruments. Alternatively, one or moredeployment actuators or tools 320 may be utilized to control the varioussurgical instruments, as explained in detail below. Housing 16 may alsoinclude one or more instrument controllers 20 disposed thereon that areactuatable to control (activate, rotate, extend, operate, articulate,etc.) one or more surgical instruments or the deployment tool 320.

Turning now to FIG. 2 which shows one embodiment of the catheter 10having four tubes 110 a-110 d disposed therein that define four channels107 a-107 d for housing a corresponding number of surgical instruments,e.g., instruments 125 and 135. More particularly, the distal end 15 ofshaft 12 is configured to operatively engage one or more working ends205 and 105 that are, in turn, configured to house one or more surgicalinstruments, e.g., surgical instruments 125 and 135, therein. As shown,working end 205 is configured to removeably engage distal end 15 or maybe configured to be integrally associated therewith. Working end 205, inturn, includes a plurality of mechanical interfaces 203, 204, 206 a and206 b that are dimensioned to operably engage a corresponding pluralityof interfaces 103, 104, 106 a and 106 b disposed on working end 105.

The mechanically engaging interfaces, namely, interfaces, 203, 204, 206a and 206 b on end 205 and the mechanically engaging interfaces, 103,104, 106 a and 106 b on end 105 are configured to assure accurate andconsistent alignment of the internal working channels 110 a-110 d,mechanical actuators 115 a, 115 b and internal electrical connections117. As such, the various electrical and mechanical connections ofworking end 105 are universal and allow selective replacement (orinterchangeability) of different working ends onto working end 205 asneeded. A surgeon can select a working end 105 containing specificsurgical tools needed for a particular surgical procedure and engage theworking end 105 onto end 205, thereby reducing the need to feed a newsurgical instrument down the channel of the catheter 10 for each use.Alternatively, a surgeon may manually load working end 105 with specificinstruments needed for a particular surgical procedure or order a customset of instruments that is loaded by a manufacturer.

As explained in more detail below with respect to the operation of thecatheter 10, the surgeon has the ability to rotate the working end 105independently (or with shaft 12) to orient a new surgical instrument,e.g., instrument 125, for use inside a operating cavity as neededwithout compromising the integrity of the operating cavity and withouthaving to replace instruments during a surgical procedure due tosterilization or mechanical issues. Moreover, each instrument, e.g.,instrument 125, may be rotated into place and deployed (via controllers20 and actuators 115 a and 115 b) either separately or in tandem asneeded. Certain channels, e.g., channels 107 b and 107 d, may be leftavailable in case a new or unanticipated instrument is needed during agiven procedure.

For example, the working end 105 may include a vessel sealing device 125and an electrosurgical pencil 135, which are each independentlydeployable, activatable and controllable via one or more controllers 20disposed on the housing 16 or as part of the accessory equipment 60.Vessel sealer 125 is configured to allow a surgeon to selectively andremotely grasp, dissect, manipulate, seal and/or cut vessels and tissue.Electrosurgical pencil 135 allows a surgeon to remotely coagulate andcut vessels and tissue. When not in use, each instrument, e.g., sealer125, is housed within a corresponding channel or pocket 110 a disposedin working end 105. A remote actuator, e.g., actuator 115 a, isactivated to deploy the vessel sealer 125 from the distal end 103 of theworking end 105.

Actuator 115 a may be multifunctional and include one or more cables orother electrical connections that enable the surgeon to deploy, rotate,articulate, extend and otherwise operate the surgical instrument duringuse thereof. Similarly, electrical connections 117 may bemultifunctional as well and allow the surgeon to activate variouselectrical components of the surgical instrument as well as actuatevarious electrically-controlled operating components (motors, solenoids,gears, etc.).

Other instruments may be selected as part of a given working end 105that perform different functions depending upon the particular surgeryinvolved. Examples of instruments that may be utilized within thevarious working channels include vessel sealing instruments e.g., asdescribed in commonly-owned U.S. application Ser. No. 11/348,072,electrosurgical pencils, e.g., as described in commonly-owned U.S.application Ser. No. 11/337,990 and ablation instruments, e.g., asdescribed in commonly-owned U.S. application Ser. No. 11/236,400. Otherinstruments and devices that may be utilized include: biopsyinstruments, needles, probes, sensors, graspers, forceps, knives,scissors, sutures, stents, irrigators, balloon dissectors, suctiondevices, stabilizers, blunt dissectors, lasers, optical devices,implants, anchors, tissue ablators, etc. These instruments may be housedwithin the articulating members of the end of the shaft 12.

FIG. 3 shows another embodiment of a working end 305 for use withcatheter 10 that includes two internally disposed channels 307 a and 307b defined therein for use in deploying various surgical instruments 335a-335 d. Channels 307 a and 307 b are generally offset relative to oneanother and extend through the distal end 303 of working end 305,thereby allowing independent and/or simultaneous deployment of surgicalinstruments 335 a-335 d to the operating cavity. Working end 305 alsoincludes a plurality of elongated cavities 310 a-310 d disposed aroundthe internal peripheral surface thereof that are dimensioned to houseone or more instruments therein. Similar to the working ends 105 and 205above, working end 305 may be configured to house various surgicalinstruments needed for a particular surgical procedure, thereby reducingthe need to feed a new surgical instrument down the channels 307 a, 307b of the catheter 10 for each use.

Working end 305 also includes a deployment tool 320 that operablyconnects to one or more controllers on the housing 16 that is configuredto allow selective deployment and control of a particular surgicalinstrument into a respective working channel, e.g., 307 a, and into theoperating cavity. More particularly, deployment tool 320 includes ashaft 318 that is selectively reciprocateable within the catheter 10 toallow a surgeon the ability to selectively engage a desired surgicalinstrument, e.g., instrument 335 c, from the surgical instrument'srespective cavity 310 c and deploy the instrument 335 c into theoperating cavity via a working channel 307 a or 307 b. The deploymenttool 320 may include a universal coupling 315 disposed at a distal endthereof that is configured to engage a corresponding coupling 322 a, 322c disposed on the surgical instrument 335 a, 335 c, respectively. Theuniversal coupling 315 may be multifunctional and include one or moreactuators, cables or electrical connections that enable the surgeon toengage, deploy, rotate, articulate, extend and otherwise operate thesurgical instrument (or components thereof, e.g., variouselectrically-controlled operating components (motors, solenoids, gears,etc.)) during use.

In the particular embodiment shown in FIG. 3, the various tools includean electrosurgical pencil 335 a, a needle electrode 335 b, a biopsy tool335 c and a deployable stent 335 d. Again, other instruments may also behoused within the various cavities of working end 305 including: probes,sensors, graspers, forceps, knives, scissors, sutures, irrigators,suction devices, stabilizers, dissectors, lasers, optical devices,implants, anchors, tissue ablators, etc.

The remote proximal end 13 of the catheter shaft 12, the housing 16 orthe accessory equipment 60 may include one or more sensors or indexingdevices 17 that are configured to locate, orient or “index” the varioussurgical instruments disposed within working end 305 and, e.g., thecavity location and/or particular function of each instrument. Forexample, the housing 16 (or equipment 60) may include a senor or anindexing tool (or other visual indicator) 17 that corresponds to bothinstrument type and instrument location within the working end 305. Thesurgeon may then manually engage a desired surgical instrument (oractivate an automatic instrument engagement protocol) based on theindexing information displayed on the housing 16 (or equipment 60).Moreover, it is contemplated that a second set of cavities (not shown)may be defined within the working end 305 for “used” instruments, samplespecimens or additional working components (e.g., additional stents).

Sensors 17 may also be used to confirm engagement/disengagement of theproper instrument, mechanical failure, or various operatingcharacteristics of the surgical instruments as needed during use,impedance matching, temperature monitoring, etc. Various tissueparameters may also be determined by the sensor(s) 17, e.g., tissueimpedance, tissue temperature, tissue moisture, etc.

FIGS. 4A-4C shows an example of a surgical instrument or tool 435 thatmay be selectively deployable from one or more of the hereindescribedworking ends for use with catheter 10. More particularly, and similar tothe instruments described above, instrument 435 is a biopsy toolconfigured to fit within working channel 407 defined in tube 402. A toolactuator 415 is reciprocateable within the working channel 407 andallows a surgeon to remotely operate the biopsy tool 435 as needed. Forexample, the biopsy instrument 435 is initially deployed by moving theactuator 415 distally past the end of working channel 407 which opens apair of cup-like opposing jaws 436 a and 436 b of the biopsy tool 435about a pivot 438 via a spring bias 427 disposed at the proximal end ofthe tool 435. Once the opposing jaws 436 a and 436 b are opened, thebiopsy tool 435 may be moved into position to engage specimen tissue1000 as shown in FIG. 4A.

Once positioned, the surgeon pulls the actuating tool proximally (whilemaintaining shaft 12 in place), which forces the opposing jaws 436 a and436 b to close about the tissue specimen 1000 as shown in FIG. 4B. Theedges of the opposing jaw members 436 a and 436 b include sharpenededges that allow the jaw members 436 a and 436 b to cut and capture thetissue specimen 1000 between the jaw members 436 a and 436 b. Once thetissue 1000 is cut, the surgeon continues to pull the tool 435proximally so that the tissue specimen 1000′ may be safely storedbetween the opposing jaw members 436 a and 436 b within working channel507 (See FIG. 4C).

FIG. 5 shows another embodiment of a working end 505 for use withcatheter 10 that includes one or more internally disposed tubes 502 aand 502 b having channels 507 a and 508 a defined therein for use indeploying various surgical instruments, e.g., instrument 535 withinchannel 507 a. More particularly, working end 505 is selectivelyengageable with end 205 of catheter 10 in a similar manner describedabove with respect to FIG. 2. In the instance wherein the actuating andelectrical cables need to be properly aligned to operate a particularsurgical instrument, it is necessary to ensure proper alignment of theworking channels 507 a and 210 a of ends 505 and 205, respectively.

For example, in order to ensure actuating cables 515 and 215 align forproper operation of instrument 535, the proximal end 525 a of tube 502 amay be configured to align with the distal end 225 a of tube 202 a. Oneor more alignment interfaces 532 and 232 may be employed on ends 525 aand 225 a, respectively. The alignment interfaces 532 and 232 may alsobe employed to register the electrical cables 517 and 217 on each end525 a and 225 a. Ideally, the mechanical interfaces 532 a and 232 a areuniversal connections or interfaces, thereby allowing interchangeabilityof various working ends of surgical instrumentation with differentlyconfigured or “loaded” configurations of surgical tools. The mechanicalinterfaces 532 a and 232 a may be threaded, snap-fit, tongue and grooveor any other suitable type of mating connectable interfaces.

FIG. 6 shows another embodiment of a catheter 10 that includes a seriesof interchangeable working ends 605 a-605 c that may be selectivelyengaged to end 205 of catheter 10. Each interchangeable working end 605a-605 c includes a plurality of cavities 610 a-610 d, 610 a′-610 d′ and610 a″-61 0 d″ defined therein for housing various surgical instruments.One or more mechanical interfaces (similar to the mechanical interfaces532 and 232 described above) may be employed to align and/or secure theplurality of working ends 605 a-605 c to one another and/or to end 205.A deployment tool 615 may be utilized to remotely engage, deploy and/oroperate any one of the instruments, e.g., instruments 635 a, 635 b,within the operating cavity as needed. For example, in the particulararrangement shown in FIG. 6, as many as twelve instruments may be usedwithin a surgical cavity without having to remove and insertinstrumentation in a conventional manner. One or more actuating cables615 and electrical connections 617 may be employed to permit remoteengagement, deployment and operation of the various surgicalinstrumentation as needed.

The present disclosure also relates to a method for performing asurgical procedure and includes the steps of: providing a housing andattaching a flexible, elongated shaft with distal and proximal ends tothe housing. The method also includes the additional steps of: engagingone or more working ends (in series) to the distal end of the housing,the working end including a plurality of tubes disposed therein thatdefine a corresponding plurality of working channels for housing acorresponding plurality of surgical instruments, and controlling anactuator to engage one or more of the corresponding plurality ofsurgical instruments and deploy the corresponding surgical instrument toan operating cavity as needed for use during a surgical procedure.

The method may also include the steps of indexing the plurality ofsurgical instruments disposed in the working end(s), and providingfeedback to the surgeon relating to the status and/or location of eachof the plurality of surgical instruments. The feedback relating to thestatus and/or location of each of the plurality of surgical instrumentsmay include indicia displayed on the housing such as: “stored”,“deployed”, “in use”, “disposed” and/or “malfunction”.

From the foregoing and with reference to the various figure drawings,those skilled in the art will appreciate that certain modifications canalso be made to the present disclosure without departing from the scopeof the present disclosure. For example and as mentioned above, thehousing, generator, suction/irrigation equipment and/or the accessoryequipment may include a sensor or indexing mechanism or tool whichorients and “indexes” the various surgical instruments, before, duringor after use. The indexing tool may be configured to provide real-timefeedback to the surgeon as to the status and location of eachinstrument. As a new instrument or magazine of instruments is added orinterchanged, the indexing tool automatically (or manually) updates thedisplay or index on the appropriate system component (e.g., housing,generator, suction/irrigation equipment and/or the accessory equipment)thereby providing accurate information to the surgeon.

Moreover, there have been described and illustrated herein severalembodiments of a catheter with various working ends for treating tissueand performing other surgical procedures. While particular embodimentsof the disclosure have been described, it is not intended that thedisclosure be limited thereto, as it is intended that the disclosure beas broad in scope as the art will allow and that the specification beread likewise. Therefore, the above description should not be construedas limiting, but merely as exemplifications of particular embodiments.Those skilled in the art will envision other modifications within thescope and spirit of the claims appended hereto.

1. An apparatus for performing a surgical procedure, comprising: aplurality of surgical instruments; a housing having an elongated shaftwith proximal and distal ends; a working end selectively engageable withthe distal end of the elongated shaft, including a plurality of tubesdisposed therein that define a plurality of working channels configuredto house the plurality of surgical instruments; and an actuatordimensioned for selective reciprocation within the working end, whereinrotation of the working end with respect to a longitudinal axis of theelongated shaft engages one of the plurality of surgical instrumentswith the actuator to deploy the surgical instrument to an operatingcavity as needed during a surgical procedure.
 2. An apparatus forperforming a surgical procedure according to claim 1, wherein theactuator is configured to allow remote operation of the at least onesurgical instrument within the operating cavity.
 3. An apparatus forperforming a surgical procedure according to claim 1, wherein theplurality of surgical instruments is arranged in an array-like mannerwithin the working channels of the working end.
 4. An apparatus forperforming a surgical procedure according to claim 1, wherein theplurality of surgical instruments is selected from a group consistingof: vessel sealers, coagulators, biopsy instruments, needles, probes,sensors, graspers, forceps, knives, scissors, sutures, stents,irrigators, balloon dissectors, suction devices, stabilizers, bluntdissectors, lasers, optical devices, implants tissue ablators andanchors.
 5. An apparatus for performing a surgical procedure accordingto claim 1, wherein the actuator includes at least one of an actuatingcable and an electrical cable operably connected thereto configured toat least one of engage, deploy and operate one of the plurality ofsurgical instruments.
 6. An apparatus for performing a surgicalprocedure according to claim 1, wherein the housing is adapted toconnect to at least one of an energy source, an irrigation source, asuction source and accessory equipment configured to operably connect toat least one of the plurality of surgical instruments.
 7. An apparatusfor performing a surgical procedure according to claim 6, wherein atleast one of the housing, energy source, irrigation source, suctionsource and accessory equipment is configured to include a controllerdisposed thereon for remotely controlling the actuator.
 8. An apparatusfor performing a surgical procedure according to claim 6, wherein atleast one of the housing, energy source, irrigation source, suctionsource and accessory equipment is configured to include a sensordisposed thereon for indexing the plurality of surgical instruments inthe working end.
 9. An apparatus for performing a surgical procedure,comprising: a plurality of surgical instruments; a housing having anelongated flexible shaft with proximal and distal ends; a working endincluding a plurality of tubes disposed therein that define a pluralityof working channels configured to house the plurality of surgicalinstruments, the working end being selectively engageable with thedistal end of the elongated shaft; and an actuator dimensioned forselective reciprocation within the working end, wherein rotation of theworking end with respect to a longitudinal axis of the elongated shaftengages at least one of the plurality of surgical instruments with theactuator to deploy the at least one surgical instrument to an operatingcavity as needed during a surgical procedure.
 10. An apparatus forperforming a surgical procedure according to claim 9, wherein theactuator is configured to allow remote operation of the at least onesurgical instrument within the operating cavity.
 11. An apparatus forperforming a surgical procedure according to claim 9, wherein aplurality of working ends having a plurality of surgical instruments areattached to the elongated shaft in series.
 12. An apparatus forperforming a surgical procedure according to claim 11, wherein thehousing is configured to include a sensor disposed thereon for indexingthe plurality of surgical instruments attached to the flexible shaftfrom each of the working ends.